key: cord-0971927-y8uylqv3
authors: Rasouli, Jonathan J.; Shin, John H.; Than, Khoi D.; Gibbs, Wende N.; Baum, Griffin R.; Baaj, Ali A.
title: Virtual Spine: A novel, international teleconferencing program developed to increase the accessibility of spine education during the COVID-19 pandemic
date: 2020-05-28
journal: World Neurosurg
DOI: 10.1016/j.wneu.2020.05.191
sha: 6e3c3d998f18115623ea8cc5a4f610ede74371af
doc_id: 971927
cord_uid: y8uylqv3

Background The coronavirus (COVID-19) pandemic effectively ended all major spine educational conferences in the first half of 2020. In response, the authors formed a “virtual” case-based conference series directed at delivering spine education to healthcare providers around the world. We herein share the technical logistics, early participant feedback, and future direction of this initiative. Methods The Virtual Global Spine Conference (VGSC) was created in April 2020 by a multi-institutional team of spinal neurosurgeons and a neuroradiologist. Biweekly virtual meetings were established wherein invited national and international spine care providers would deliver case-based presentations on spine and spine surgery-related conditions via teleconferencing. Promotion was coordinated through social media platforms such as Twitter. Results VGSC recruited over 1000 surgeons, trainees and other specialists, with 50-100 new registrants per week thereafter. An early survey to the participants, with 168 responders, indicated that 92% viewed the content as highly valuable to their practice and 94% would continue participating post-COVID. Participants from the United States (29%), Middle East (16%), and Europe (12%) comprised the majority of the audience. Approximately 52% were neurosurgeons, 18% orthopaedic surgeons, and 6% neuroradiologists. A majority of participants were physicians (55%) and residents/fellows (21%). Conclusion The early success of the VGSC reflects a strong interest in spine education despite the COVID pandemic and social distancing guidelines. There is widespread opinion, backed by our own survey results, that many clinicians and trainees wish to see “virtual” education continue post-COVID.

The coronavirus (COVID-19) pandemic has resulted in devastating medical and socioeconomic 25 consequences around the world. [1] [2] [3] [4] While aggressive, early interventions such as widespread 26

quarantine and social distancing have demonstrated benefit in mitigating new cases, one of the 27 unforeseen consequences has been the near-total cancellation of major specialty-specific 28 conferences, both nationally and internationally. 1, 5, 6 This has resulted in interruptions in the 29 education and training of neurosurgical residents, fellows, and faculty. 1, 3, 6 In addition, the long-30 term consequences of these necessary social distancing measures to the future of organized 31 neurosurgery and global neurosurgical advocacy have yet to be fully understood. 32

In response, there has been widespread adoption of telemedicine and teleconferencing platforms 34 such as Zoom (Zoom Inc, San Jose, CA), to promote "virtual," long-distance education to 35 residents and faculty. 7, 8 For example, numerous neurosurgical residency programs such as 36

Harvard, Johns Hopkins, Cleveland Clinic, and Mount Sinai have developed weekly, virtual 37 lectures that have been live-streamed on Zoom. Due to security concerns in the Zoom software, 38 the participants of these programs have generally been restricted to the faculty and residents 39 enrolled at the host institution. 9 40 41 As a result, healthcare providers who are not affiliated with the host institutions and wish to 42 participate in these virtual educational conferences have, to date, essentially been excluded. 43

Those who appear to be most vulnerable are national and international healthcare providers and 44 trainees who work in hospitals, clinics, and in countries outside the United States and 3 address potential disparities in the access to spine education created by the COVID-19 pandemic. 47

The VGSC is a multi-institutional, multi-disciplinary, international teleconferencing series 48 featuring orthopaedic and neurosurgical spine surgeons, neuroradiologists, and practitioners in 49 other spine-related specialties. In this manuscript, we share the technical logistics, early 50 participant feedback, and future direction of this initiative as it continues to grow and evolve to 51 address discrepancies in spine surgical education across the world. The audience was primarily comprised of surgeons, radiologists, residents, advanced practice 66 providers (APPs), and medical students. After an unfortunate "Zoombombing" incident during the first teleconference, several security 84 measures were enacted that successfully prevented any further occurrences. "Zoombombing" is 85 the unwanted infiltration of a conference by hackers who then subsequently post material that is 86 likely to be disturbing and offensive to the audience. First, participants were initially screened 87 via the home webpage and sent an e-mail invitation after faculty approval. Second, the link to the 88 Zoom meetings was not advertised on social media and was password encrypted. The password 89 was only available to participants who were on the e-mail registry. Third, approximately 15 90 minutes prior to conference start, the faculty hosts and lecturers would log into the Zoom 91 conference room, register themselves as "hosts," and subsequently restrict screensharing to 92 hosts-only. After these measures were initiated there were no further Zoombombing episodes. The reported region/country of origin of our participants can be seen in (Figure 1) . Participants 115 from the United States (29%), Middle East (16%), Europe (12%), Central/South America 116 (8.5%), and India (6.6%) comprised the majority of the audience. Approximately 52% were 117 neurosurgeons, 18% orthopaedic surgeons, and 6% neuroradiologists (Figure 2) . A majority of 118 participants were physicians (55%) and residents/fellows (21%) (Figure 3) . The majority of the 119 audience was male (70%). Of the participants who were from the United States, a majority lived 120 in the Northeast and Southeast (41% and 23%, respectively) (Figure 4) . 121 122

The COVID-19 global pandemic has necessitated numerous, drastic changes in healthcare policy 124 and the structure and organization of organized specialty-specific conferences. 1 teleconferencing. 15, 16, 19 Furthermore, the increasing popularity of social media platforms, such as 168

Twitter, have also allowed for the ability to quickly and effectively advertise and promote 169 educational programs to a wide audience. 8,20 170 171 There have been on-going concerns about the security and stability of Zoom, given numerous 172 reported incidences of "Zoombombing" during conferences worldwide. 16 Fortunately, since we 173 instituted the protective measures described earlier, there have been no further "Zoombombing" 174 instances. We believe it is of critical importance to avoid public sharing of Zoom chatrooms and 175 to restrict screen sharing to the hosts-only. Furthermore, Zoom Telecommunications have 176 released several software updates and security patches to address these issues. 9 177 178 Future goals of the VGSC are to continue to deliver high-quality sessions led by prominent 179 surgeons and other specialists, to better engage and collaborate with national organizations, and 180 to collect long-term, granular data to better assess effectiveness and quality of this program. Our 181 preliminary survey suggests that there is potential to increase viewership by further engaging with medical students and residents. We believe teleconferencing will play a dominant role in the 183 future of both healthcare delivery and resident education. Further data will be required to assess 184 the long-term effectiveness and longevity of the VGSC model in future studies. 

COVID-19 and neurosurgical 212 practice: an interim report

Clinical Characteristics of Coronavirus Disease

The impact of COVID-19 on 217 neurosurgeons and the strategy for triaging non-emergent operations: a global 218 neurosurgery study

Presenting Characteristics, Comorbidities, 220 and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the

The Coronavirus Disease 2019 Crisis as Catalyst for 223

Telemedicine for Chronic Neurological Disorders

Impact of COVID-19 on neurosurgery resident research training

Overcoming distance: video-conferencing as a clinical 228 and educational tool among surgeons

Telemedicine in neurosurgery during the 230 novel coronavirus (COVID-19) pandemic

Zoom Hits Milestone on 90-Day Security Plan, Releases Zoom 5

Global neurosurgery: models for 236 international surgical education and collaboration at one university

Global neurosurgery: the current capacity and 239 deficit in the provision of essential neurosurgical care

Neurosurgery Initiative at the Program in Global Surgery and Social Change

COVID-19 and spinal surgery

Neurosurgical teleconsultations in 245 northern Norway

Telemedicine has now come of age

Clinical telehealth across the 251 disciplines: lessons learned

Teleconferencing 253 using multimedia messaging service (MMS) for long-range consultation of patients with 254 neurosurgical problems in an acute situation

Virtual interactive presence for 256 real-time, long-distance surgical collaboration during complex microsurgical procedures

The initial 259 experience of InterSurgeon: an online platform to facilitate global neurosurgical 260 partnerships

Specialized Social Media Team Increases 262

Online Impact and Presence: The Journal of Neurosurgery Experience

This manuscript is not being published or under consideration in a different journal or publication. The authors all contributed equally to the development, research, writing, and editing of the manuscript. In addition, none of the authors have financial or ethical conflicts of interest that could potentially influence the integrity of our manuscript.Abbreviation List: COVID-19 = coronavirus, VGSC = virtual global spine conference, APP = advanced practice provider, PPE = personal protective equipment